Do you remember the game you played as a child in which someone whispers a secret to the next person, and each person repeats the secret down the line until the last person speaks the secret aloud? The secret may have started out as “Jenny was out picking berries today so she can bake a pie.” By the end of the line, it may have become “Jenny is so allergic to cherries that she breaks out into hives.” The point is that messages can become very distorted when they travel through the chain of command in the upward flow of communication. Arredondo (2000) says that when communicating with superiors it is important to state needs clearly, explain the rationales for requests, and suggest the benefits to the larger unit. It is also important to listen objectively to the response of the supervisor, because there may be good reasons for granting or not granting the request.

Arredondo (2000) gives the following tips for talking to your supervisor:

Ideally, professional nurses should view themselves as equals in their interactions with members of other health care disciplines, and their approach to communication should be a lateral one, even with physicians. The basis of this communication is the ability of the nurse to see himself or herself as competent and worthy of being an equal to physicians, social workers, dietitians, and others. Gaining this self-confidence is a major goal of every recent graduate. Using effective communication practices, as described in this chapter, and communication reporting tools (see Chapter 11 for information on hand-off communication) will help you achieve that goal.

Even a recent graduate will soon be providing direction to licensed nursing personnel and unlicensed assistive nursing personnel (see Chapter 14 for further information on delegation). It is important to remember that these people have needs for satisfaction and self-esteem, too. Directions do not need to be given in the form of authoritative commands unless an emergency demands immediate action in a prescribed way. Marquis and Huston (2014) suggest that when you provide direction, you need to think through exactly what you want to be done, by whom, and when. You need to get the full attention of the other person so you know that he or she hears you accurately. You should provide clear, simple instructions in step-by-step order, using a supportive tone of voice. Before the other person goes to do the task, ask for feedback to verify that he or she has accurately heard your instructions. Follow-up is necessary to be sure your directions were followed and to find out what happened, in case something more needs to be done. Involving personnel who are at other levels of nursing care in the planning and evaluation of patient care will increase those associates’ sense of responsibility for the outcomes and will help you to seem less authoritarian. Refer to the checklist in Critical Thinking Box 12.3 to identify areas needed for growth.

To summarize, men and women have innately different communication styles, often developed from their childhood experiences and environment. To be successful in the workplace, we all have to learn as much as we can about communication differences, identify our own styles, and have the flexibility to use other communication techniques as situations warrant.

In addition to formal messages, communication can be informal. This type of communication flows upward, downward, and horizontally and is known as the grapevine. Whereas some people think of this kind of communication as gossip, others say it is the way things really get done. No matter how we describe the grapevine, we know it flourishes in all settings. People enjoy the satisfaction of the social interaction and recognition associated with the grapevine. It also provides information to employees that may not be easily obtained in any other way. It may be the quickest way to find out what the supervisor really values or what new job openings are available (Marquis & Huston, 2014) (Fig. 12.1).

Mindell (2001) provides the following tips for controlling the grapevine:

We must be aware of stereotypes that may interfere with our ability to see people as individuals. If we view people according to stereotypes, we might limit the way we perceive their communication. Even positive stereotypes make assumptions about people that may be inaccurate and thus may limit the nurse’s ability to use all of his or her work skills effectively (Critical Thinking Box 12.4).

According to Arredondo (2000), communication goes through many filters when a person interacts with someone whom he or she perceives as different. Some of those filters are related to culture, gender, education level, age, and experience. When messages go through these filters, the messages may change because the actual communication symbols are interpreted according to a person’s own cultural values and beliefs. This change may lead to misperceptions and misinterpretations. Communication is improved when we become more aware of the filters we use.

Within the work culture, people often communicate using jargon, inside jokes, or slang unique to the work setting. Acronyms are an example of jargon that health care workers understand but patients may not. It may seem to patients and their families that we are speaking in a code or foreign language. To interact effectively, we need to speak clearly, avoid jargon or slang, and keep our communication short and to the point. Long explanations with lengthy terminology can be confusing to people who are not familiar with the health care culture.

Differences in the cultural backgrounds of workers can be a real asset. Sometimes we may have to provide care to patients who speak languages other than English, and we may need to enlist the skills of co-workers to translate or interpret, especially when cultural values influence the interpretation of the patient’s behavior. We need to understand and respect cultural differences in patients. We can learn how to do this by learning about the differences among our co-workers. Respect and empathy enhance communication with people from other cultures, whether those people are patients or co-workers (Giger, 2013).

Mindell (2001) provides some guidelines for writing. First, determine whether you need to write in a formal way. Most upward communication needs to be formal, which means you should use proper titles, format, grammar, spelling, and punctuation. Never allow something you have written to be sent without careful proofreading. Nothing creates a negative impression faster than sloppy work, misspelled words, or poor grammar. If you need to, ask someone else to do this proofreading; be sure it is done well. Take the time to make necessary revisions before sending your written work to others.

Also decide what your purpose is before you write (Marquis & Huston, 2014). This will help you to organize your thoughts so that everything you write helps to meet your purpose. Learn to write exactly what you mean. Choose words that are clear and specific. Often this means simple, small words. Be careful to use technical words only when you are sure you are choosing the correct words and your reader will understand you. Keep your sentences short and simple, with only one idea in each sentence.

When you learn to be clear and concise, you will write the essential information without many lengthy phrases. Your readers will be very grateful if they can follow your thoughts easily. Make sure the first sentence in each paragraph identifies the key point for that paragraph. The reader should not have to guess what you are trying to say. Use a format that guides the reader. This means that main points on each page are easy to locate visually, and concepts are identified by headings or titles. Remember, how well you write strongly influences how you are evaluated. What you put down on paper makes a lasting impression, and people will make judgments about your credibility and professionalism for a long time after you have actually written the words.

Many of us let our anxiety intimidate us when it comes to public speaking. However, public speaking can be a great chance to show off our skills, our ability to be creative, and our willingness to be a star entertainer. Think of your presentation as a wonderful opportunity to have the attention of others on just you, even if only for a few minutes (Arredondo, 2000).

A well-planned rehearsal provides the chance to see how long it will take you to say what you want, and it will help you feel more comfortable saying the words easily. Here are some tips on presentation preparation from Kushner (2004) and Peoples (1992).

There are reasons that people are not good listeners (Arredondo, 2000). We simply do not pay enough attention; we hear what we want to hear and filter out the rest. Listening requires concentration, and that means doing nothing else at the same time. Some people think of listening as a passive behavior; they want to be in control by talking more. We think a lot faster than people speak, so we often think way ahead, think about other things, or daydream. Maybe too many distractions are interfering with listening, such as background noises or movements.

One of the most problematic reasons for ineffective listening is that people allow their emotions to dictate what they hear or do not hear. If the message is making demands on us to do more, change what we do, or do better, we may stop listening and start dealing with our own feelings of anger, guilt, or anxiety. We may start planning our own defensive response while the other person is still talking.

Think about situations where you’ve had difficulty listening, understanding, or remembering what was said. Consider these examples:

It becomes essential to develop effective listening skills (Arredondo, 2000). Here are some tips: